{
  "abstract": "Background Despite high rates of successful recanalization after endovascular thrombectomy (EVT) for acute ischemic stroke, many patients fail to achieve functional independence, a phenomenon often referred to as futile recanalization. While patient-level predictors have been extensively studied, the impact of regional differences in patient populations, healthcare systems, and stroke care delivery remains less well defined. This study evaluates regional variation in functional outcomes following EVT across the United States.Methods We analyzed data from the Stroke Thrombectomy and Aneurysm Registry (STAR), including 12,800 patients from 52 centers, of whom 10,776 had 90-day follow-up. Successful recanalization was defined as TICI ≥2B. Modified Rankin Scale (mRS) was used as a categorical variable to define good functional outcome (mRS0-2) and as a continuous measure for improvement (discharge to 90 days). Futile recanalization as mRS 3-6 despite successful recanalization. US centers were categorized into 4 regions (Northeast, Southeast, Midwest and West). Regional comparisons were performed using multivariable logistic and linear regression models adjusted for demographics, comorbidities, baseline disability, admission NIHSS, stroke characteristics, treatment times, and procedural factors. Propensity score matching was used for secondary comparisons between the Southeast and Northeast.Results Among patients with successful recanalization, the overall rate of futile recanalization was 42%. Rates of 90-day functional independence varied by region: 44% in the Northeast, 44% in the Midwest, 49% in the West, and 39% in the Southeast. Using the Southeast as the reference, treatment in other regions was associated with higher odds of good 90-day functional outcome and greater functional improvement. When the Southeast region was used as a reference in the multivariate analysis, all 3 alternate regions were associated with higher adjusted odds of functional independence at 90 days (aOR [1.2-3], P<0.01) and higher odds of improving (i.e. lower) mRS at 90 days compared to discharge (P<0.01). In the propensity-matched cohort (867 patients per group), patients treated in the Northeast had higher rates of functional independence at discharge (43% vs 34.5%, P<0.001) and at 90 days (49% vs 41%, P=0.002) compared with those in the Southeast. Baseline and procedural characteristics were well balanced after matching.Conclusion Significant regional variation exists in functional outcomes following EVT in the US despite similar recanalization rates. These findings suggest that system-level and regional factors may influence post-reperfusion recovery. Further studies incorporating healthcare delivery and regional infrastructure metrics are needed to identify modifiable drivers of these disparities and improve stroke outcomes nationwide.Disclosures D. Hijazi: None. R. Chalhoub: None. A. Spiotta: None. A. Rai: None. S. Wolfe: None. C. Ogilvy: None. J. Mascitelli: None. F. Siddiqui: None. B. Howard: None. M. Cawley: None. M. Park: None. M. Moss: None. J. Dye: None. K. Limaye: None. A. Polifka: None. R. Grandhi: None. M. Mokin: None. R. Starke: None. S. Guess: None. S. Surbhi: none. n. goyal: none. a. alawieh: none.Abstract E-034 Figure 1",
  "authors": [
    {
      "affiliations": [
        "Department of Neurosurgery, Emory University, Atlanta, GA"
      ],
      "name": "D Hijazi"
    },
    {
      "affiliations": [
        "Neurosurgery, Emory University School of Medicine, Atlanta, GA"
      ],
      "name": "A Chacon"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Emory University, Atlanta, GA"
      ],
      "name": "R Chalhoub"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Emory University, Atlanta, GA"
      ],
      "name": "A Tfaily"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, The Medical University of South Carolina, Charleston, SC"
      ],
      "name": "A Spiotta"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, West Virginia University, Morgantown, WV"
      ],
      "name": "A Rai"
    },
    {
      "affiliations": [
        "University of Missouri - Kansas City School of Medicine, Missouri, KY"
      ],
      "name": "S Wolfe"
    },
    {
      "affiliations": [
        "Thomas Jefferson University Hospital, Philadelphia, PA"
      ],
      "name": "P Jabbour"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Beth Israel Deaconess Medical Center Brain Aneurysm Institute, Boston, MA"
      ],
      "name": "C Ogilvy"
    },
    {
      "affiliations": [
        "Kingwood, TX"
      ],
      "name": "M Ezzeldin"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, The University of Texas Health Science Center at San Antonio, San Antonio, TX"
      ],
      "name": "J Mascitelli"
    },
    {
      "affiliations": [
        "Department of Neurology, University of Michigan Health-West, Wyoming, MI"
      ],
      "name": "F Siddiqui"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Emory University, Atlanta, GA"
      ],
      "name": "B Howard"
    },
    {
      "affiliations": [
        "Neurosurgery, Emory Univerisity School of Medicine, Atlanta, GEORGIA"
      ],
      "name": "M Cawley"
    },
    {
      "affiliations": [
        "Bronx, NY"
      ],
      "name": "D Altschul"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Virginia, Charlottesville, VA"
      ],
      "name": "M Park"
    },
    {
      "affiliations": [
        "University of Washington, Seattle, WA"
      ],
      "name": "M Levitt"
    },
    {
      "affiliations": [
        "Radiology, Mayo Clinic, Rochester, MN"
      ],
      "name": "W Brinjikji"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, Washington Regional Medical Center, Fayetteville, AR"
      ],
      "name": "M Moss"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Loma Linda University, Murrieta, CA"
      ],
      "name": "J Dye"
    },
    {
      "affiliations": [
        "Department of Neurology, Indiana University Health, Indianapolis, IN"
      ],
      "name": "K Limaye"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Illinois at Chicago, Chicago, IL"
      ],
      "name": "A Alaraj"
    },
    {
      "affiliations": [
        "UTMB, Houston, TX"
      ],
      "name": "P Kan"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Florida, Jacksonville, FL"
      ],
      "name": "A Polifka"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Utah, Salt Lake City, UT"
      ],
      "name": "R Grandhi"
    },
    {
      "affiliations": [
        "University of Buffalo, Buffalo, NY"
      ],
      "name": "M Mokin"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Miami Health System, Miami, FL"
      ],
      "name": "R Starke"
    },
    {
      "affiliations": [
        "Department of Neurology, University of Tennessee Health Science Center\\Semmes Murphey Foundation, Memphis, TN"
      ],
      "name": "S Guess"
    },
    {
      "affiliations": [
        "Department of Medicine, Division of Med General Internal Medicine, Emory University, Memphis, TN’"
      ],
      "name": "S Surbhi"
    },
    {
      "affiliations": [
        "Department of Neurology, University of Tennessee Health Science Center\\Semmes Murphey Foundation, Memphis, TN"
      ],
      "name": "N Goyal"
    },
    {
      "affiliations": [
        "Neurosurgery, Emory University, Atlanta, GA"
      ],
      "name": "J Grossberg"
    },
    {
      "affiliations": [
        "Neurosurgery, Semmes Murphey Clinic, Memphis, TN"
      ],
      "name": "A Alawieh"
    }
  ],
  "title": "E-034 Geographic disparities in functional recovery after successful thrombectomy in the United States",
  "uid": "bec3c1ab-bd2d-5639-8aae-868753d4efcf"
}